Doula Legislation

Advocating for Better Births

In the fall of 2023, SD Representative Mellissa Heermann was approached by Michelle Sands, Obstetrics Director at Brookings Health System, and Victoria Wakeman, Program Coordinator for the Brookings Health System Doula Program.  The ball began rolling to pass legislation that would allow doula services to be a covered Medicaid benefit.

The trio reached out to South Dakota Doulas to be the umbrella organization and resource to educate the public and doulas about the progress.

House Bill 1081 was heard by the Health and Human Services Committee in the South Dakota Legislation on January 25th, 2024.  Testifying in support of HB1081 were Michelle Sands, Victoria Wakeman (lobbyist), Kelsie Thomas (lobbyist), several state organizations, and a mother who had received doula support.  In opposition was Matt Althoff, Secretary of the Dept of Social Services.  The proposed legislation was tabled, as the Department of Social Services asked to work directly with the doulas to coordinate Medicaid payment for doula services through DSS’ Pregnancy Medical Home. 

From the Department of Social Services website, high level objectives of the Pregnancy Medical Home include:
• Increase timeliness and utilization of prenatal, postpartum, and well-child care.
• Provide and connect pregnant and postpartum women with supports that help them to
be healthy and thrive.
• Improve health outcomes for pregnant women and their babies.  

South Dakota Doulas is eager to begin work on creating and implementing this programming with the Department of Social Services so that all families have access to doula support.


Listen to the audio of the January 25th, 2024 hearing HERE





Sioux Falls Simplified: This group is working to make doulas more accessible statewide

Argus Leader:  SD intends to expand Medicaid to doula services, official says 



Why Should Medicaid Pay for Doula Services?

The Care Is Evidence Based

The benefits of doula care are supported by consistent, high-quality research.  Cochrane systematic reviews have reported the positive effects of continuous labor support since 1995.  In 2017, the most recent review analyzed data from 26 individual studies involving more than 15,000 women.

The review found numerous benefits to continuous labor support and no known harms of such care, including:

  • 39% reduction in the likelihood of cesarean births
  • 15% greater likelihood of a spontaneous vaginal birth
  • 10% reduction in the use of pain medications
  • Shorter labor by an average of 41 minutes
  • 31% reduction in reporting a negative birth experience
  • 38% decrease in the baby’s risk of a low five minute Apgar score


Maternal Mortality is a Crisis in Our State

In a 2020 report by the South Dakota Advisory Committees to the U.S. Commission on Civil Rights, it was noted that there are significant maternal health disparities experienced by American Indian women in South Dakota.

Native American women in South Dakota have a mortality rate of 121.77 maternal deaths per 100,000 births, which is nearly seven times the 2018 national maternal mortality rate (17.9 maternal deaths per 100,000 births).  It is also far greater than the state’s maternal mortality rate (59 maternal deaths per 100,000 births), and  the maternal mortality rate for White women in South Dakota (44 maternal deaths per 100,000 births).

This is especially concerning considering that American Indian women make up only 18% of births within the state, while White women make up 75% of births in South Dakota.

It Saves South Dakota Money

Among Medicaid beneficiaries, research has shown that women whose labor and delivery were supported by doula care had lower cesarean and preterm birth rates and improved rates of breastfeeding initiation. Coverage of doula services are cost-effective for state Medicaid programs by preventing birth complications for mothers and newborns and a source of savings. The large cost savings of less interventions actually covers the cost of Doula care making it a cost-effective strategy to reducing health disparities, improving outcomes for mothers and babies.

And at no risk.

Every South Dakota mother and baby deserves evidence based doula care for better outcomes.  

Review our presentation to SD legislators

Images of doulas in SD helping families

Access the recording of the presentation for SD legislators

A woman smiles while watching a webinar

Legislation from 2024

South Dakota House Bill 1081


 This bill is designed to outline the reimbursements of doula services by the state Medicaid program. Currently, doula services are not covered by Medicaid and this leaves a large number of pregnant individuals without access to doula care.


01/24/2024: HB1081 First Read in House and referred to House Health and Human Services

01/25/2024 Scheduled for hearing SDBP Audio 23:31
01/25/2024 House Health and Human Services Tabled, Passed, YEAS 13, NAYS 0.

TBD: Health and Human Services Committee Hearing

Sponsors: Representatives Heermann (prime), Blare, Deutsch, Drury, Duba, Emery, Moore, Mulder, Nelson, Perry, Pourier, and Wittman and Senators Tobin (prime) Foster, Larson, and Reed

Members of the House Health and Human Services Committee:

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